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t <br /> Advanced CHAIN OF CUSTODIORECORD <br /> � `° <br /> GeoEnvironmental, Inc. Date 1 16'� Page 3 <br /> of <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006- Fax (209) 467-1118 <br /> Giem ��r'"--- L,.G�h ._.. "C.L.L�'1 �j�,�� Project Manager squired <br /> r , Tests R <br /> i I i L' <br /> Phone NU-tuber 0 <br /> i � — <br /> nature <br /> Samplers: (Signature)g ) `� Invoice: <br /> Project Name C_afv) � 0 AGEK <br /> c� I Client ❑ <br /> Sample Location Sample Type No. of <br /> Number Description <br /> Date Time Water Solid Q Notes <br /> Comp, Grab. Air Corns. <br /> 13 Sci 1 <br /> � a Lis- C� k' LJ <br /> I sca <br /> C 3 � ft " WJ _ 9 `;- ` 1 '�; KL <br /> e inquis a y: ignatur f ecerve y: ignature Date rime <br /> Re mquished by: (Signatur Received by: (Signature) Date/Time. <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) �- '� Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Lab a �!b atelTime <br /> ( d p <br /> Method of Shipment: Libor at ry N e <br /> lNuk <br /> Special tnstructions: I hereby authorize the performance of the above Indicated work. <br /> 1 <br />